Housecalls go mobile

Seeking a better, more efficient way to see his patients, William C. Thornbury, Jr., MD, RPh, CEO and medical director of Medical Associates of Southern Kentucky, found a way to do housecalls by smartphone.

The primary care doctor conducted a two-year clinical study in which he consulted patients via e-visit, 24 hours a day. The study demonstrated that his efforts could solve the primary care provider shortage and cut costs for his practice. As a result, Thornbury launched Me-Visit, a web portal that offers around-the-clock access to patients using a mobile device or computer.

In an interview with Clinical Innovation + Technology, Thornbury said the idea for mobile e-visits came after he trained in the Lean strategy principles developed by Toyota. Since his practice in Glasgow had to turn away two or three potential new patients a day, he and his team began working on ways they could accommodate more patients.

He learned the root cause was that 30 to 40 percent of the patients did not need to be seen in the clinic but the fee-for-service model called for them to come in for a follow-up visit. That “doesn’t make it the right thing to do,” he said. Meanwhile, many patient encounters can be completed more safely online. “When you program a computer to ask certain questions it asks those questions every single time, not like a doctor who might forget.”

After using the tool for about a year, Thornbury said 97 percent of his patients said they preferred it to going into the office. “We began to take more patients and spent more time with patients who needed it.” In 2011, he went from functionally no new patients to an average of about one new patient a day. In, 2012, he said the number of new patients increased 20 percent from the 2011 baseline. So far in 2013, he has grown his practice another 20 percent. And, even though e-visits are not appropriate for all patients, the ones who did use the service still lowered the cost of care for everyone by 15 percent, he said. 

To be successful with e-visits, Thornbury said family physicians need to be engaged. “The medical home model is the least expensive, most efficient way to provide care but we haven’t been able to provide telehealth inside that model. Once you make the healthcare visit mobile, you can go inside the medical home.”

Because the physician already knows the patients, he or she can take care of moderate problems. In his second year, Thornbury added chronic disease management, including hypertension and diabetes, to his e-visit menu. “Seventy percent of healthcare costs are for chronic disease care. [E-visits] change everything.”

To use Me-Visit, patients log into the secure website. They provide their health history when they sign up, then choose their physician. The interrogation engine asks a series of questions which helps fill out the medical history. Physicians can either call the patient or conduct a face-time visit with cell phones. Thornbury said about 30 percent of encounters warrant a phone call but very few call for a video visit. “Once you begin to conduct visits like this, you’ve gone to a brand new generation of telemedicine” that’s cheaper and more efficient than other forms of telemedicine, he says.

Thornbury charges $32 per e-visit, which covers physicians’ intellectual work while still saving the healthcare system money, he said. “The American Medical Association tells us by 2020, we will be 100,000 doctors short and we’ve had a decade of EMRs slowing doctors down. Our technology speeds them up and the doctor shortage goes away.”